Indiana Gov Mike Pence signed HB 1034 yesterday, giving Indiana residents direct access to evaluation and treatment by a physical therapist (PT) without a physician referral. The law, which will take effect on July 1, allows for evaluation and up to 24 days of treatment without a referral but continues to require a referral for spinal manipulation and sharp debridement. Prior to passage of the new law, a referral was required for all physical therapist services, both evaluation and treatment. Enactment of HB 1034 means that all 50 states and the District of Columbia now have direct access to evaluation, and 48 states plus DC, including Indiana, have some level of direct access to treatment.

"We are thrilled that Indiana has become the latest state to offer patients the choice of direct access to physical therapist services. Ensuring patient access is a cornerstone of APTA's vision and mission," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "I congratulate our colleagues in the Indiana Chapter for their resilience and dedication in enacting this vital legislation after many years of tough battle. I also want to thank Rep David Frizzell for authoring the bill and Sen Patricia Miller for sponsoring the bill in the Senate."

As we celebrate this major legislative success in Indiana and important milestone for the profession, APTA will also continue to work toward improved patient access across the country, including the removal of restrictions in states that continue to impede patient access to physical therapist services.

Survey Finds Nearly Half of US Adults Uninsured in 2012

Nearly half of working-age adults, or 84 million adults aged 18-64, were uninsured for at least part of 2012, say authors of a report based on findings from the Commonwealth Fund Biennial Health Insurance Survey of 2012. The survey also found that the number of young adults aged 19-25 without insurance decreased from 13.6 million to 11.7 million, or from 48% to 41% from 2010 to 2012. Nearly 40 million (75%) of low-income workers (incomes under 133% of the federal poverty level) were uninsured or underinsured in 2012; almost 21 million (59%) of moderate-income workers (incomes 133%-249% of poverty level) were underinsured; and 41% of working adults (75 million people) had trouble paying their medical bills or were paying down medical debts in 2012.

The survey was conducted by Princeton Survey Research Associates International, April 26 through August 19, 2012, via cell phone and landline telephone interviews, in English and Spanish. The sample included 4,432 adults over age 19.

The authors of the report, Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act, concluded that, "The combination of new affordable coverage options and insurance market reforms in the Affordable Care Act has the potential to reverse growth in the number of people who have gaps in their health insurance, are underinsured, spend large shares of their income on premiums, struggle to pay medical bills, delay getting needed care because of cost, and do not have a regular source of health care."

APTA Podcast Offers Instruction on PQRS Falls Measures Reporting

A new APTA podcast walks you through the reporting process for these measures, measure 154 Falls: Risk Assessment and measure 155 Falls: Plan of Care. Listen to APTA's Heather Smith, program director of quality, explain how these measures are a paired set, what to do if the patient’s falls history is positive or negative, and how to report if you have a valid reason not to perform the risk assessment.

APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/Podcasts/, or subscribing to APTA podcasts on iTunes.

Proposed Bill Provides for Tricare Coverage of Targeted Therapies

After denials by Tricare to cover a young patient's physical therapy on a horse, and similar denials for other beneficiaries, a proposed bill would require the military health insurer to cover certain forms of physical therapy.

Rep Michael Burgess (R-TX) introduced the Rehabilitative Therapy Parity for Military Beneficiaries Act (HR 1705) on Wednesday. The law calls for Tricare to cover "therapies provided on a horse, balance board, bolster, and bench" if these therapeutic exercises or activities are included in the individual's plan of care. APTA was heavily involved in developing the bill's language, which bolsters the argument that a horse, like a ball or balance board, is simply a tool the physical therapist uses and not an alternative form of therapy.

"Every patient is different, has a different set of needs, and therefore may respond very differently to various types of therapy," Burgess stated. "Ensuring access to needed services is critical for patients to maintain, improve, or regain function."

APTA applauds the efforts of Rep Burgess to ensure all patients have access to therapy services, particularly those who are fighting for our country and whose families bear the greatest weight.

More than 6,976 individuals, both APTA members and nonmembers, sent letters through APTA's Legislative Action Center and Patient Action Center on this issue, far exceeding the initial goal of 16,000 letters over 72 hours. This single effort surpasses any other letter-writing campaign on behalf of the profession, APTA said. Through e-mails and social media outreach, the Student Assembly Board met its goal with 13 hours left in the campaign. Josh D'Angelo, Student Assembly Board president, said, "Thank you to the many students, professionals, friends, and families who submitted letters and encouraged others to do the same. Your efforts brought attention to critical issues facing physical therapy, took advocacy to classrooms and clinics across the nation, and served to unify and strengthen our voice. The Student Assembly Board of Directors is inspired by your leadership, dedication, and passion."

The goal of FAS is to encourage students to participate in advocacy and unite with fellow peers on a national scale on a single issue. Members can still take action to support this legislation through APTA's Legislative Action Center and can learn more about APTA's grassroots network and other ways to stay active on APTA's advocacy initiatives in the Take Action webpage.

By 2030, several million more people will suffer from heart failure, and related total treatment costs will more than double, from 2012 levels, says the American Heart Association (AHA) in a policy statement published online April 24 ahead of print in Circulation: Heart Failure.

AHA estimated future costs of heart failure (HF) using a methodology that it developed to "project the epidemiology and future costs of HF from 2012 to 2030." The model did not double-count costs associated with comorbid conditions and assumed that heart failure rates based on sex, age, and race/ethnicity will not vary, and increasing costs and technological innovation will not vary. AHA projected that by 2030, more than 8 million people will suffer from heart failure; real total direct medical costs related to heart failure will increase from $21 billion to $53 billion; and total treatment costs will increase from $31 billion to $70 billion.

The statement authors concluded, "The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed."

In December 2012, APTA discussed how physical therapists can help patients manage chronic heart failure in this podcast.

Member Comment Period Opens for 'Guide to Physical Therapist Practice' Revisions

APTA's Guide to Physical Therapist Practice, 2nd Edition, has been undergoing an extensive review and revision process. The revised chapters for the third edition of the Guide are being made available from April 24 through July 1, 2013, for member comment. Members are invited to review the revised chapters and provide feedback via survey.

APTA encourages all members to assist in this process. The deadline to submit the survey is Monday, July 1, 2013.

2013 House of Delegates Motions (Packet I) Posted

In preparation for the 2013 House of Delegates (House), today APTA posted this year's House motions to the APTA website and the House of Delegates Community.

Although motions have always been available to members, this is first time motions have been accessible to nonmembers, too. Also new this year, individual comment pages have been established to enable public discussion of the motions.

In a video address posted at the 2013 House of Delegates page, where motions are listed, Speaker of the House Shawne E. Soper, PT, DPT, MBA, encouraged members to use the comment areas, as well as Twitter, but not as a substitute for contacting their delegate directly to provide feedback.

Delegates are welcome to engage in these public forums but should continue using the House of Delegates Community (open to all APTA members), for delegate discussion. "Packet I," a compilation of all main motions to this year's House of Delegates, can be accessed on the House of Delegates Community.

The House of Delegates Handbook will be posted to the House of Delegates Community on Friday, April 26, and background papers for the House motions will be posted on Friday, May 10.

As in previous years, delegates and members can continue to access the discussion boards in the House of Delegates Community: The Packet I discussion board is for conceptual discussion surrounding this year's motions, and the Motion Cosponsors discussion board is for delegations to pledge cosponsorship for a motion. However, only the chief, section, and assembly delegates, or their designees, may post messages on the House discussion forum on behalf of their delegations.

A tailored physiotherapy program improved self-reported functional outcomes and hip range of motion in patients undergoing hip resurfacing, say authors of a study published electronically ahead of print in April by the Clinical Rehabilitation journal.

The study was a randomized controlled trial with 6-, 16-, and 52-week follow-ups. It included 80 men with a median age of 56 who were listed for primary hip resurfacing surgery between 2009 and 2010. The authors, from the Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK, compared tailored postoperative physiotherapy programs with standard physiotherapy. They found that at 1 year, the mean (SD) Oxford Hip Score of the group using the tailored program was higher than the control group at 45 versus 39.6, respectively. In addition, 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group.

The authors concluded that the "study confirms that a tailored rehabilitation programme following Metal On Metal Hip Resurfacing Arthroplasty (MOMHRA) improves self-reported functional outcomes and quality of life compared with a traditional rehabilitation programme."

The nation's recent recession, far more than changes in the health care system, is the main cause of slow growth in health care spending, says a new study commissioned by the Kaiser Family Foundation and conducted by the Altarum Institute. Some 77% of the recent decline in health care spending can be attributed to broader changes in the economy, Kaiser says, with structural changes in the health care system "playing a modest role."

According to the Centers for Medicare and Medicaid Services Office of the Actuary, health care spending grew by 3.9% annually 2009-2011, the smallest increase since the federal government began tracking the statistics in 1960, with a small increase to 4.3% in 2012.

Because health care spending is a major driver of federal and state budgets, Kaiser commented, determining whether or not the growth pace will pick up or remain sluggish has major implications. To the extent it's recession-driven, health care spending potentially will bounce back with the economy; to the extent it's affected by structural changes, historically low growth rates could continue. The analysis suggests it's premature to credit policy and marketplace changes with the slowdown in spending growth, but it notes that major elements of the Accountable Care Act "have not yet been implemented and could dampen growth in the future."

Innovation Summit Viewing Party Winners Announced

APTA's recent Innovation Summit: Collaborative Care Models introduced the association's virtual conference concept, which allowed some 1,200 viewers to experience the summit online, along with the onsite presenters and audience. APTA encouraged virtual attendees to form viewing parties, where they could engage in the summit as a group, and the association offered incentives for participation.

The following viewing parties earned APTA's accolades and prizes for their groups:

CMS Issues FAQ on Manual Medical Review

CMS has added a frequently asked questions (FAQ) document to its Therapy Cap webpage regarding manual medical review for outpatient therapy claims that exceed $3,700. This document provides responses to questions regarding the process that the Recovery Audit Contractors (RACs) will use to review claims under the manual medical review process in 2013.

Included in a new report that addresses the US national debt and deficit is the recommendation to restrict physician self-referrals and narrow the "in-office ancillary services" (IOAS) exception to the Stark self-referral laws.

The Simpson-Bowles deficit commission today released its final report on the national debt and the deficit. The 60-page document outlines principles, a 4-step process that includes $2.5 trillion in deficit reduction, and steps to sustain the lower levels of spending, even with other spending priorities on the horizon. Within the deficit reduction proposals is yet another suggestion to close the IOAS exception. APTA applauds this news, which shows continued momentum in our efforts to reform this policy. APTA is reviewing the report for any additional proposals that may impact APTA and its members.

The report specifically says that "physician self-referrals should be further restricted and better monitored, including narrowing the 'ancillary service exception.'" This recommendation follows a similar recommendation in the president's Fiscal Year 2014 Budget, released last week, that suggested therapy services should be removed from the IOAS exception.

For more news on this and other APTA related advocacy efforts continue to monitor APTA's federal advocacy page.

Opposition testimony to HB 1039 was provided by the Texas Orthopaedic Association and a physical therapist employed in a physician-owned clinic. The Texas Association of Acupuncture and Oriental Medicine also provided testimony against the bill, expressing concern about the ability of physical therapists to perform dry needling.

Improving patient access in the Lone Star state has been an important goal for the Texas Chapter.

The legislation awaits action by the House Public Health Committee; the deadline for house bills to be reported out by house committees is Monday, May 6. Meanwhile, the chapter is also advocating for House Bill 2357 and Senate Bill 1099, legislation that would provide title protection for the doctor of physical therapy (DPT) and master of physical therapy (MPT). The senate bill passed the Texas Senate on Thursday, April 18; the house version has passed through committee and is awaiting a vote by the Texas House.

CA Joint Manipulation Bill Voted Down, But Reconsideration Granted

Physical therapists (PTs) from across California descended on the state capitol in Sacramento on Monday to show their opposition to Senate Bill 381, legislation aimed at prohibiting physical therapists from performing joint manipulation. California SB 381, authored by state Sen Leland Yee and sponsored by the California Chiropractic Association, was heard on April 15 in the California Senate Business, Professions, and Economic Development Committee.

The legislation would prohibit anyone other than a chiropractor, physician, or osteopath from performing joint manipulation in the state and make the term "joint manipulation" synonymous with "joint adjustment." Under SB 381, any health care practitioner other than a chiropractor, physician, or osteopath who performs a joint manipulation in California would be considered to be engaged in the unlawful practice of chiropractic and result in the possible revocation or suspension of the health care practitioner's license.

While SB 381 was voted down 6-1, the bill was granted "reconsideration," meaning that the Senate committee could reconsider the legislation at a future date. California Chapter members are encouraged to continue contact their state legislators and the members of the Senate Business, Professions, and Economic Development Committee to oppose SB 381, as the bill may be reconsidered as early as this Monday, April 22.

Watch the hearing at: www.youtube.com/watch?v=lx_hD1udS4c. (The first part of the video shows testimony from supporters of SB 381; testimony from PTs in opposition to SB 381 begins at the 21:15 mark.)

A specific nonoperative physical therapy program was effective for treating atraumatic full-thickness rotator cuff tears in nearly 75% of patients, say authors of a multicenter prospective cohort study published by the Journal of Shoulder and Elbow Surgery in March.

The authors designed a physical therapy program based on a systematic review of extant literature and evaluated patients at 6 and 12 weeks. During these evaluations, patients chose from 3 courses of action: cured with no formal follow-up scheduled; improved with subsequent therapy and a scheduled evaluation in 6 weeks; and unimproved/optional surgery. At 1 and 2 years, patients were called and asked whether they underwent surgery after their last evaluation. The authors used a Wilcoxon signed rank test with continuity correction to compare initial, 6-week, and 12-week outcome scores.

Among the 452 patients included in the study, patient-reported outcomes improved significantly at 6 and 12 weeks, say the authors. Patients had surgery less than 25% of the time and elected to do so between 6 and 12 weeks, with few undergoing surgery between 3 and 24 weeks.

2012-2013 Pittsburgh-Marquette Challenge Deadline

The deadline for the Foundation for Physical Therapy's Pittsburgh-Marquette Challenge is closing in fast. Check here to see if your school is on the list of schools that have already contributed to this year's challenge!

The deadline for sending in contributions is this Monday, April 22. Contribute today! For late donations, please notify Erica Sadiq at EricaSadiq@foundation4pt.org.

To engage physical therapy students in advocacy to advance the physical therapist profession, the Student Assembly Board of Directors (SABoD) and APTA have teamed up to implement a Flash Action Strategy (FAS) to initiate student support for the Physical Therapist Workforce and Patient Access Act (HR 1252/S 602), legislation reintroduced in the 113th Congress to include physical therapists in the National Health Service Corps. The FAS is a student-driven strategy to send letters to Congress on this issue during a 72-hour period April 23-25. Education programs across the country have been asked to RSVP that they will send a letter through APTA's Legislative Action Center or Patient Action Center during this time, with the goal of producing 16,000 letters to Congress. The FAS affords a unique opportunity for students to participate in advocacy and unite with fellow peers on a national scale on a single issue.

PT Spokesperson Featured in Washington Post on Workout Recovery

APTA Media Corps member Robert Gillanders, PT, DPT, OCS, was featured in an April 16 Washington Post MisFits column, "Ice, heat or a little of both? How do you recover from a hard workout?" Gillanders explained how the use of ice, which lacks sufficient evidence behind it, can actually slow the healing process, and why he prefers heat. He also underscores the importance of movement by saying, "Humans did quite well for thousands of years without ice or heat, just the natural healing process, which included lots of movement."

Call for Nominations: Development of CPGs and CPAs Workshop

APTA sections that want to send members to the association's upcoming workshop on developing clinical practice guidelines (CPGs) and clinical practice appraisals (CPAs) must submit their nominations by April 26.

APTA is hosting its second CPG/CPA workshop July 24-26 at association headquarters to guide participating section members who want to develop CPGs/CPAs in their areas of clinical practice. The 3-day workshop will provide knowledge, skills, and tools for both beginner and advanced members, who will work in teams to learn how to develop evidence-based documents. The first workshop was held last summer.

Section leaders have been asked to nominate up to 2 members whose hotel and travel expenses for the workshop will be covered by APTA. Sections also may send additional members at the section's expense.

All names, whether paid or not, must be submitted by section leaders only, using the online nomination form. Individual members who want to attend the workshop should ask their section leadership to nominate them. Please contact Sarah Miller with questions or for more information.

Move Forward Radio Recognizes Parkinson Disease Awareness Month

Move Forward Radio talked to Terry Ellis, PT, PhD, NCS, today about the benefits of physical therapy for those with Parkinson disease (PD). April is the National Parkinson Foundation's Parkinson Awareness Month.

In the 29-minute episode, Ellis described how exercise can help offset many of the disease's familiar symptoms, noted the challenges that individuals with PD often have with multitasking, and outlined the importance of seeing a physical therapist early in the progression of the disease to maintain quality of life and avoid damaging falls, among other topics.

Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

PTs Sought for Survey on Physical Therapy Role in Managing Schizophrenia

Researchers from the International Organization of Physical Therapists in Mental Health are seeking input from US physical therapists on using exercise to help manage people with schizophrenia. The organization is a subgroup of the World Confederation for Physical Therapy.

The 20-minute survey will collect such data as current position, any training in mental health, and referral mechanisms, in addition to physical activity for this population. Complete the survey.

The survey deadline is April 28. Contact A. Soundy for more information.

CMS to Host Session on Billing and Coding With Electronic Health Records

CMS wants to help health care providers code their billing claims appropriately in this increasingly electronic environment. The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) will host a presentation and "listening session" on May 3 in Woodlawn, Maryland, to discuss the impact of electronic health records (EHRs) on coding trends, the increase in code levels billed for some Medicare services, and developing standards for coding with EHRs.

After a break from the presentations, invited speakers will discuss key issues such as the impact of EHRs on the quality of clinical care, provider efficiency, and coding challenges and opportunities facing various groups, including hospitals, clinicians, and other interested stakeholders.

CMS provides a list of invited speakers and online registration at this link.

APTA Members Assist Critically Injured at Boston Marathon

A team of 70 members of APTA's Massachusetts Chapter, stationed at the Boston Marathon finish line on April 15 when tragedy struck, stepped in despite a chaotic scene to help injured people. These volunteers, led by Dave Nolan, PT, DPT, OSC, consisted of physical therapists and physical therapist students from Northeastern University, Simmons College, and Boston University. Nolan said, "All are physically OK but are certainly dealing with tremendous emotional challenges right now. I am proud of how each member reacted in the face of catastrophe to provide exceptional care for the critically injured."

Massachusetts Chapter President George Coggeshall, PT, DPT, reported that no APTA members who were runners, spectators, or volunteers were hurt in the blast*; however, there are members whose family and loved ones were among the more than 170 injured people. Coggeshall expressed sincere thanks to those who aided the victims and everyone who reached out to the Massachusetts Chapter. "Thank you for your many emails and calls expressing your concerns, caring, compassion and love," Coggeshall said. "We will do our best to follow the footsteps of those chapters who have survived adversity and tragedy."

If you are interested in helping people affected by this tragic event, Massachusetts Governor Deval Patrick and Boston Mayor Tom Menino have announced the formation of The One Fund Boston. Learn more about The One Fund Boston.

*Update - 4/19/13: New information on the Boston Marathon bombing indicates that an APTA member, Lee Ann Yanni, PT, and her husband, Nick, were injured there. According to a local news source and a Today show interview, Yanni suffered a broken leg, shrapnel wounds, and temporary hearing loss. The blast ruptured her husband's eardrums. The couple was cheering on a friend who had just finished the race.

Correction: This story was updated 4/18/13: Northeastern University was previously misidentified as Northern University. We apologize for the error.

Forum Focuses on Therapy Cap Repeal, Service Corps Loan Repayment

More than 260 physical therapists, physical therapist assistants, and students from across the United States wrapped up APTA's annual Federal Advocacy Forum in Washington, DC, today.

"The forum provides an invaluable opportunity for APTA members to hear from decision makers and communicate with elected officials," explained APTA President Paul Rockar Jr, PT, DPT, MS, during the forum. "Lawmakers also have the chance to learn about the challenges facing our patients, which aids discussion about the issues of significance to the physical therapy profession and the patients we serve."

Topics discussed at this year's forum included the Medicare Access to Rehabilitation Services Act (HR 713/S 367), which includes permanent repeal of the therapy cap, and the Physical Therapist Workforce and Patient Access Act (HR 1252/S 602), which would add physical therapists to the list of professionals eligible to participate in the National Health Service Corps Loan Repayment Program. Members also lobbied Congress to support APTA's sustainable growth rate (SGR) priorities. Earlier today, forum participants visited members of Congress and their staffs on Capitol Hill to advocate for these important issues.

On Monday, Mike Allen, chief White House correspondent for Politico and creator of Politico Playbook and Politico Morning Money, gave the breakfast keynote address. Later, Neera Tanden, president of the Center for American Progress and counselor to the Center for American Progress Action Fund, discussed the Affordable Care Act and the health care climate in Washington, DC. Forum breakout sessions featured updates to legislative issues facing the physical therapy profession, strategies and techniques for effective lobbying, and updates on APTA's PT-PAC and grassroots advocacy efforts.

Cardin, Lockard, and Klonowski Recognized at APTA Forum

At the APTA Federal Affairs Forum today, APTA President Paul Rockar Jr, PT, DPT, MS, conferred APTA’'s 2013 Public Service Award to Sen Ben Cardin (D-MD) for his longtime support of the physical therapy profession and his leadership to repeal the Medicare therapy cap. The Public Service Award recognizes legislators, agency officials, health and legislation association staff, and public figures who support physical therapy on a national level.

Rockar presented APTA's 2013 Federal Government Affairs Leadership Award to APTA member John Lockard, PT, OCS, owner of Northwest Physical Therapy in Philadelphia, for his work with Rep Allyson Schwartz (D-PA) on initiatives to move toward comprehensive reforms of Medicare payment and delivery systems. The award honors APTA members who make significant contributions to APTA's federal initiatives.

Rockar also recognized physical therapist Mike Klonowski, PT, DPT, PCS, who is currently treating Sen Mark Kirk (R-IL) after the lawmaker's stroke in January 2012.

From left: Paul Rockar stands with Federal Government Affairs Leadership Award winner John Lockard and Drew Bossen of the Iowa Chapter, who nominated Lockard.

CEO John Barnes Leaving APTA

The American Physical Therapy Association today announced that CEO John Barnes will be leaving the organization effective July 31. The Board of Directors will launch a national search for a new CEO in the near term, and members will receive information on the process to be used in the search. The Board will appoint an interim CEO to lead the organization during the search process and will announce the interim appointment prior to July 31.

"The Board is grateful to John for his 6 years of service," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "John has been instrumental in bringing a new perspective to the management of APTA as a very successful professional association. Based on a collaborative assessment of next steps for the organization, we believe that this is a time for a change in organizational leadership."

During Barnes' tenure from 2007-2013, APTA increased its membership by 15%, increased its revenues by 20%, and increased its meeting attendance by 51%, providing outstanding meetings and other professional development opportunities for physical therapists and physical therapist assistants. Barnes oversaw an internal reorganization and a review of governance structure and policy. Due to APTA's solid foundation, the association is well poised to move to its next level of growth.

CMS Issues New Guidance for Rehabilitation Agencies

CMS has issued additional guidance for, and changes to, requirements that rehabilitation agencies must meet to participate in the Medicare program, including changes that will impact their operations. State surveyors will use this guidance in determining whether or not providers are in compliance with regulations.

Among the significant changes in the March 15 Transmittal 83, CMS established "criteria" for approval of extension locations, which includes a requirement that the extension location be "situated within a 30-mile radius of where 90 percent of the agency's primary site's population lives." CMS indicates that if unusual geographic features exist, consideration would be given for longer or shorter distances. Other areas addressed in the transmittal include requirements related to administration, policies, care planning and patient care, staffing, emergency care, equipment maintenance, and infection control.

Rehabilitation agencies should carefully review the guidance in Transmittal 83 and implement any necessary changes to ensure compliance with the new guidance. APTA will be seeking further clarification and requesting that CMS address concerns with some of the requirements included in the transmittal.

Over the last decade, employer-sponsored insurance (ESI) coverage in the United States has eroded substantially, say authors of a study published this month by the State Health Access Data Assistance Center, a Robert Wood Johnson Foundation-funded entity. The authors noted that the findings highlight the importance of monitoring and evaluating the impacts of the Affordable Care Act on ESI at the state level. Although ESI coverage declined among nonelderly Americans, ESI is expected to remain as the leading way this population group obtains coverage, they concluded.

Researchers obtained state-level data for this study from the Annual Social and Economic Supplement of the Current Population Survey, and the Medical Expenditure Panel Survey-Insurance Component. The study period was from 1999/2000 to 2010/2011.

Analysis of the 2 national surveys revealed that ESI coverage among nonelderly Americans declined from 69.7% to 59.5%. This represents a 10.2 percentage point decline despite a 3.1 percentage point increase in public coverage. While most states experienced significant declines in ESI coverage, the percentage varied widely by state and income, with coverage falling less for high-income groups (400% federal poverty level or above) than for lower income groups (200% federal poverty level or below). Nationwide, private sector ESI coverage fell from 58.9% to 52.4%, and single-person premium costs doubled while family premiums increased 125%. Employee contributions also rose from 17.5% to 20.8% of the total premium.

APTA is highly encouraged by the proposal within President Obama's fiscal year 2014 budget, released yesterday, to exclude therapy services, including physical therapy, along with radiation therapy and advanced imaging from the in-office ancillary services (IOAS) exception of the Stark self-referral laws.

The Office of Management and Budget concluded that closing the loophole for these services would provide a savings of $6.1 billion over the standard 10-year budget window, providing further evidence that these self-referral arrangements lead to overutilization of Medicare services and should be addressed by Congress.

On its own for many years and more recently as part of the Alliance for Integrity in Medicare (AIM) coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups, APTA has long advocated for exclusion of physical therapy from the IOAS exception. APTA agrees with the Administration's proposal on physician self-referral and believes this issue should be addressed as part of any fundamental delivery system reform.

APTA and its AIM partners continue to be gravely concerned about the ongoing misapplication of the IOAS exception to the physician self-referral law, believing this loophole results in increased spending, unnecessary use of medical services, and potentially compromised patient choice and care. Studies published by the New England Journal of Medicine, Health Affairs, and the Government Accountability Office, among others, have highlighted abuses that result from physician self referral. These ongoing issues serve only to erode the integrity of the Medicare program and undermine patient care.

APTA and AIM now strongly urge the 113th Congress to follow the recommendations of the Administration budget and pass legislation to remove physical therapy, advanced diagnostic imaging, anatomic pathology, and radiation therapy from the IOAS exception.

Health Care Reform: Implementation Progress Report, Free From APTA

If you missed last week's live event with APTA Vice President of Public Policy, Practice, and Professional Affairs Justin Moore, PT, DPT, you can access the webinar recording online. Discover what Moore revealed about how the Patient Protection and Affordable Care Act (PL111-148) will impact physical therapy practice, payment, and professional issues; how clinicians, business owners, and rehabilitation managers can successfully navigate changes while working to improve access, lower costs, and reshape the health care workforce; and examine the significant opportunities and challenges physical therapists (PTs) will face in the coming year. The webinare is free to APTA members; nonmembers pay $169.

Winners Selected in APTA's Fit After 50 Member Challenge!

APTA members and the public have voted for the physical therapist who they feel best keeps active and fit at age 50+ and encourages patients and members of the community to do the same. Patsy Shropshire, PT, age 52, of Dallas, Texas, was chosen the winner. Paul Sullivan, PT, MHS, Cert. MDT, age 52, of Barrington, Illinois, was chosen second place finalist, and Bill Case, PT, SCS, age 56, of Houston, Texas, is the third place finalist. Read their stories.

April 2013 Board of Directors Meeting to Be Broadcast Online

APTA's upcoming Board of Directors (Board) meeting will be broadcast online for APTA members, April 11-13.

All open sessions of the meeting will be livestreamed using a single, static camera so that members can listen to the Board's discussions. Archived video will be available through May.
The broadcast begins Thursday, April 11, at approximately 3:30 pm, ET with a strategic planning session. An agenda detailing other meeting activities and broadcast times is available on the livestream page: www.apta.org/Livestream.

This is the third time that a Board meeting has been livestreamed for members.

Study: Physician Health Influences Patient Health

Physicians who follow preventive health measures are more likely to have patients who follow preventive health measures, according to a Canadian Medical Association Journalstudy cited in the April 8 Medscape News Today.

The study included 1,488 physicians and their 1,886,791 adult patients. The authors examined 8 indicators, such as flu vaccination and mammograms, and found that for all indicators, patients were more likely to undergo preventive practices if their physicians had undergone the same practices (P < .05). The authors found a stronger relationship between similar preventive practices than dissimilar ones; for example, patients of physicians who did and physicians who did not receive the flu vaccine had identical mammography rates.

In their conclusion, the authors state, "Our findings suggest that there is room for improvement in some physicians' preventive practices (particularly around screening and vaccination) and that improving the health of physicians could improve outcomes for their patients as well. We believe that programs for physician health promotion should be developed and studied to determine how best to actively encourage the healthy doctor–healthy patient association."

Physical therapists who set healthy examples for their patients are featured in the March 2013 issue of PT in Motion—read about them in "Endurance Tested."

Anderson Joins Foundation Board of Trustees

The Foundation for Physical Therapy has appointed Stephen Anderson, PT, DPT, to its Board of Trustees. Anderson is CEO of Therapeutic Associates Inc and a past president of the APTA Private Practice Section, serving from 2002 to 2008. He was honored in 2010 with the section's prestigious Robert G. Dicus Service Award and in 2005 with the APTA Federal Legislative Leadership Award for his grassroots advocacy and a passion for educating legislators about issues important to the physical therapy profession.

"Steve has been a longtime supporter of the foundation's work, both personally and professionally," said Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT. "Each of our trustees provides critical expertise in guiding the foundation. We welcome Steve as an experienced leader with a passion for the profession. He will be a tremendous asset."

Study: Physical Therapy Beneficial to Critically Ill Patients

According to a new systematic review of the evidence base for exercise in critically ill patients, physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, and peripheral and respiratory muscle strength; increasing ventilator-free days; and decreasing hospital and ICU stay.

"It is apparent that survivors of critical illness experience poor physical, functional, and cognitive outcomes often lasting for years," said the authors of a paper published in Critical Care Medicine, noting that this condition, "post intensive care syndrome," and the related "intensive care unit acquired weakness" can result in major impacts on the health and productivity of survivors and caregivers, availability of hospital beds, and health care costs.

"Early physical therapy in intensive care in increasingly recommended, and this review has found preliminary evidence that there are beneficial effects," the study said.

PT Investigating Interest in Network Focused on Rehab for People With Amputation

Louise Tisdale, PT, a clinical specialist in the United Kingdom, is investigating whether there is sufficient interest to support a new World Confederation for Physical Therapy (WCPT) network focused on rehabilitation for people with amputation. WCPT networks provide a forum for the international exchange of ideas, experience, and expertise in physical therapy. If you want to give and gain support working on rehabilitating people with amputation around the world, or if you would like to develop relationships with international peers and share information about practice, research, clinical guidelines, and outcome measures, contact Tisdale.

Healthy People 2020 Webinar: Social Determinants of Health

Healthy People 2020 places a renewed emphasis on identifying, measuring, tracking, and reducing health disparities through a “social determinants of health” approach and its new Social Determinants of Health topic area and objectives. Join other health care professionals on Wednesday, April 24, 1:00 pm-2:30 pm, ET, for a webinar that will explore conditions in the social, physical, and economic environment in which people live and their related health outcomes. Presentations will include examples of communities that are addressing the social determinants of health to reduce health disparities. Register today.

This webinar will feature representatives from the Department of Health and Human Services, The Pew Charitable Trusts, Health Resources and Services Administration, and the Centers for Disease Control and Prevention.

Last Call for Virtual Career Fair Registrations

You still have time to register
for APTA's live, online Virtual Career Fair, to be held April 9, 1:00 pm-4:00
pm ET. This first-ever online event is a great way for you to engage directly
with employers about their current and future physical therapy career
opportunities.

Participate in the Virtual Career
Fair for as long as you wish, chatting 1-on-1 with recruiters to discuss your background
and experience, and their current and future needs for physical
therapists.

California PTs Rally Against Senate Bill 381

California
physical therapists (PTs) are preparing for a key hearing and possible vote on
legislation aimed at prohibiting them from performing joint manipulation.
California Senate Bill 381 (SB 381),
authored by state Sen Leland Yee and
sponsored by the California Chiropractic Association, is scheduled to be heard on Monday, April 15, at 1:00 pm, in the California Senate Business,
Professions, and Economic Development Committee in Sacramento.

The
legislation would prohibit anyone other than a chiropractor, physician, or
osteopath from performing joint manipulation in the state and make the term
"joint manipulation" synonymous with "joint adjustment."
Under SB 381, any health care practitioner other than a chiropractor,
physician, or osteopath who performs a joint
manipulation in California would be considered to be engaged in the unlawful
practice of chiropractic and result in the possible revocation or suspension of
the health care practitioner's license.

The legislation has been introduced under the guise of "public
protection," despite that fact that there is no data or evidence suggesting that
there is a greater threat to patient safety from physical therapists performing
joint manipulation techniques. The performance of joint manipulation by
physical therapists is different from a joint adjustment performed by
chiropractors. The legislation is part of an ongoing turf battle against
qualified physical therapists who perform joint manipulation.

APTA and its California Chapter strongly oppose SB 381, as treatment
interventions do not fall under the exclusive domain of any one specific
profession. Physical therapists, chiropractors, medical doctors, and
osteopathic physicians are all educated and trained to employ joint
manipulation within the scope of their respective licenses and in a manner that
protects the public's health, safety, and welfare. Unnecessarily restricting
any qualified licensed health care providers whose education and scope of
practice includes joint manipulation from being able to provide joint
manipulation is anti-competitive, and would diminish patient choice and
increase health care costs.

California Chapter members are encouraged to contact their state legislator and the members of the Senate Business,
Professions, and Economic Development Committee to
oppose SB 381 and, if possible, attend the April 15 hearing at the state
capitol in Sacramento.

Meanwhile,
the chapter has a number of other contentious legislative battles looming this
year: legislation to provide for full patient access (Assembly Bill 1000) was
recently introduced in the California
Assembly, while legislation to repeal its current anti-POPTS law (Assembly Bill
1003) also has been introduced.

Proposed Rule Outlines Navigator Standards

The Centers for Medicare and
Medicaid Services (CMS) released a proposed rule
yesterday outlining standards that "navigators" in federally facilitated
and state partnership exchanges, also known as marketplaces, must meet.

Navigators are entities or
individuals that will provide accurate and unbiased information to consumers
about the exchanges, qualified health plans, and public programs including
Medicaid and the Children's Health Insurance Program. For those who are not
familiar with health insurance, have limited English literacy, or are living
with disabilities, navigators will help ensure that they understand their
health coverage options.

The proposed standards would help
ensure that navigators and other assistance personnel will be fair and
impartial and will be appropriately trained, and that they will provide
services and information in a manner that is accessible.

CMS also proposes 2 amendments to
the existing regulation for navigators that would apply to all navigators in exchanges,
clarifying that any navigator licensing, certification, or other standards
prescribed by the state or exchange must not prevent the application of the
provisions in the Affordable Care Act. The proposal also seeks to make entities
with relationships to issuers of stop loss insurance (policies that protect
companies against
catastrophic claims) ineligible to become navigators, including those who are compensated directly or indirectly by
issuers of stop loss insurance in connection with enrollment in qualified
health plans or non-qualified health plans. The same ineligibility criteria
that apply to navigators would also apply to non-navigator assistance personnel
providing services in any federally-facilitated exchanges, including in state
consumer partnership exchanges, and to federally funded non-navigator
assistance personnel in state-based exchanges.

In addition to navigators, consumers
will have access to assistance through services such as a call center, which
will be operated by the Department of Health and Human Services, for obtaining
referrals to the appropriate state or federal agencies, in-person assistance
personnel, certified application counselors, and agents and brokers.

ESPN's Stephania Bell Discusses ACL Tears on Move Forward Radio

ESPN’s
leading injury analyst for fantasy sports joined Move Forward Radio today to
discuss one of the most talked-about injuries in professional sports: anterior
cruciate ligament (ACL) tears.

In
the latest episode of APTA's consumer-oriented online radio show, Stephania
Bell, PT, OCS, CSCS, describes the injury that in recent years has affected
elite athletes—ranging from football's Adrian Peterson to baseball's Mariano
Rivera and skiing's Lindsey Vonn—and is becoming increasingly common among
youth and amateur athletes.

In
the interview, Bell outlines possible similarities and differences between
treatment programs for elite and nonelite athletes, and she provides advice for
parents of youth athletes about ways to protect against ACL tears, which are
more likely to be suffered by girls than boys.

Over
the course of the 37-minute episode, which was a Blog Talk Radio "Staff Pick" for April
4, Bell also describes her path to becoming the face of injury analysis for
fantasy sports at ESPN.

Move
Forward Radio airs approximately twice a month. Episodes are featured and archived at
MoveForwardPT.com, APTA's official consumer information website, and can be
streamed online via Blog Talk Radio or downloaded
as a podcast via iTunes.

APTA
members are encouraged to alert their patients to this series and other
MoveForwardPT.com resources to help educate the public about the benefits of
treatment by a physical therapist. Ideas for future episodes and other feedback
can be e-mailed to consumer@apta.org.

Updated Cochrane Review: Rehabilitation for Long-term Care Residents

Physical
rehabilitation for long‐term care residents may be effective,
reducing disability with few adverse events, but effects appear quite small and
may not be applicable to all residents, say authors of an updated Cochrane review
first published in 2009. There is insufficient evidence to reach conclusions
about improvement sustainability, cost‐effectiveness,
or which interventions are most appropriate, they add. Future large‐scale
trials are justified.

For this update, the authors
searched the trials registers of Cochrane entities, trials and research
registers, and conference proceedings; checked reference lists; contacted
authors, researchers, and other relevant Cochrane entities; and updated
searches of electronic databases in 2011 and listed relevant studies as
awaiting assessment. They selected randomized studies comparing a
rehabilitation intervention designed to maintain or improve physical function
with either no intervention or an alternative intervention in older people
(over 60 years) who have permanent long-term care residency.

Two review authors independently
assessed risk of bias and extracted data. The primary outcome was function in
activities of daily living. Secondary outcomes included exercise tolerance,
strength, flexibility, balance, perceived health status, mood, cognitive
status, fear of falling, and economic analyses. The authors investigated
adverse effects, including death, morbidity, and other events. They synthesized
estimates of the primary outcome with the mean difference; mortality data with
the risk ratio; and secondary outcomes, using vote-counting.

The authors included 67 trials
involving 6,300 participants. Fifty-one trials reported the primary outcome, a
measure of activities of daily living. The estimated effects of physical
rehabilitation at the end of the intervention were an improvement in Barthel
Index (0 to 100) scores of 6 points (7 studies), Functional Independence
Measure (0 to 126) scores of 5 points (4 studies), Rivermead Mobility Index (0
to 15) scores of 0.7 points (3 studies), Timed Up and Go Test of 5 seconds (7
studies), and walking speed of 0.03 m/s (9 studies). Synthesis of
secondary outcomes suggested there is a beneficial effect on strength,
flexibility, and balance, and possibly on mood, although the size of any such
effect is unknown. There was insufficient evidence of the effect on other
secondary outcomes. Based on 25 studies (3,721 participants), rehabilitation
does not increase risk of mortality in this population (risk ratio 0.95).
However, it is possible bias has resulted in overestimation of the positive
effects of physical rehabilitation, say the authors.

APTA Launches Regenerative Rehabilitation, Genetics Web Resources

APTA
has developed new resources to help physical therapists understand the impact
that regenerative rehabilitation and genetics have on physical therapist
practice. The Regenerative Rehabilitation webpage includes 2
podcasts, an audio course, and other relevant resources. The Genetics in
Physical Therapy webpage provides
general information, links to PT in
Motion and PTJ articles, and
features a 2-part session on genomics presented by leaders in orthopedics and
neurology at the 2013 Combined Sections Meeting.

New in the Literature: Postacute Care Site on Stroke Outcomes (Arch Phys Med Rehabil. 2013;94(4):622-629.)

Patients with stroke may make more
functional gains if their postacute care includes treatment received at an inpatient
rehabilitation facility (IRF), say authors of an article published this month in Archives
of Physical Medicine and Rehabilitation. This finding may have important
implications as postacute care delivery is reshaped through health care reform,
they add.

Researchers conducted this prospective
cohort study at 4 northern California hospitals that are part of a single
health maintenance organization. They enrolled patients with stroke (N=222)
between February 2008 and July 2010.

Baseline and 6-month assessments
were performed using the Activity Measure for Post Acute Care (AM-PAC), a test
of self-reported function in 3 domains: basic mobility, daily activities, and applied
cognition.

Of the 222 patients analyzed, 36%
went home with no treatment, 22% received home health/outpatient care, 30%
included an IRF in their care trajectory, and 13% included a skilled nursing
facility (but not IRF) in their care trajectory. At 6 months, after controlling
for variables such as age, functional status at acute care discharge, and total
hours of rehabilitation, patients who went to an IRF had functional scores that
were at least 8 points higher (twice the minimally detectable change for the
AM-PAC) than those who went to a skilled nursing facility in all 3 domains and
in 2 of 3 functional domains compared with those who received home
health/outpatient care.

Kansas Improves Patient Access to Physical Therapists

This
week APTA announced in a press release that Kansas
became the latest state to improve patient access to physical therapists. Gov
Sam Brownback signed HB 2066 into law on March 28, easing burdensome referral
requirements that impede timely care from skilled physical therapists.
Achievement of direct access in all 50 states has been a longtime and
fundamental goal of APTA.

Alliance Develops Plan to Prevent and Control Noncommunicable Diseases

The
NCD Alliance has published a detailed response to the World Health
Organization's (WHO) draft on a 2013-2020 global action plan
on noncommunicable diseases (NCDs). The alliance's 4-point plan includes
recommendations on leadership, aim, and scope; principles, objectives, and
action points; resourcing and implementation; and measuring progress,
reporting, and accountability.

The
plan says that the absence of a formal mechanism at the global level to
catalyze multisectoral action and collaboration on NCDs has been a major
weakness in the global NCD response to date. In 2011, the United Nations
mandated governments to work with "all relevant stakeholders" to
strengthen action on NCDs through effective partnerships, the alliance says.

According to a 2010 report from WHO, physical inactivity is 1 of 4 risk
factors that contributes to 80% of all NCDs. The other 3 risk factors are
tobacco use, the harmful use of alcohol, and poor diet.

Last year,
APTA's House of Delegates adopted Physical
Therapists as Expert Providers for Exercise and Physical Activity—recognizing
physical therapists as health service delivery providers of choice to prevent
or treat NCDs and their related risk factors. The position
holds that APTA seeks participation in the development and/or update of
physical activity or exercise guidelines for NCDs.

APTA Meets With CMS for Clarification on New Medical Manual Review Process

Yesterday,
APTA along with other therapy stakeholder organizations met with the Centers
for Medicare and Medicaid Services (CMS) to discuss implementation of the
manual medical review (MMR) process for outpatient therapy claims exceeding
$3,700. As reported March 22 in News Now, recovery audit
contractors (RACs) will complete 2 types of review for claims processed on or
after April 1, 2013—prepayment review for states within the Recovery Audit
Prepayment Review Demonstration, and immediate postpayment review for the
remaining states.

CMS
assured stakeholders that the agency would have the necessary safeguards in
place to ensure appropriate and fair medical review by RACs. Prior to the
meeting, the therapy organizations sent a detailed list of questions to CMS
regarding the use of the advanced beneficiary notice (ABN), RAC administration,
and outreach education to Medicare contractors, providers, and patients. CMS
indicated that it plans to issue a written FAQ of the questions submitted in
the coming weeks.

During
the meeting, CMS clarified the following:

When claims exceed the $3,700 threshold in the
states under postpayment review, the claim will be paid automatically, and
providers will receive an additional development request (ADR) from the
Medicare administrative contractor (MAC). The provider should send the ADR
directly to the RAC. If the ADR is sent to the MAC, the MAC will forward
it to the RAC for review, which will slow down the review process as the
10-day clock does not begin until the RAC receives the ADR.

The RAC will not automatically deny coverage if
an ADR is not received; it will reach out to the provider to request the
information.

After the RAC reviews the ADR, it will send the
provider a detailed review letter either stating there is no finding of
error or denying the claim. This letter will be sent by US mail, but all
payments and adjustment of payments will be made electronically.

Providers will be able to track claims
submitted to the RAC through a claims status portal, and provider
submission requests will still be sent via mail or fax (the provider can
also send a DVD or CD to the RAC). Providers who are enrolled in
Medicare's ESMD system can submit claims electronically.

If the provider is has more than 1 therapy
clinic, the MMR will be completed by the RAC with jurisdiction over the
region in which the provider's practice is headquartered. RACs will look
only at claims above the $3,700 threshold, and claims will be reviewed on
a claim-by-claim basis and will not be bundled (first claim in, first
claim out).

Providers should use the ABN in the same manner
for claims above and below the therapy cap. This means that ABNs should be
issued only for services that the provider believes are not medically
necessary and coverage will be denied. If the patient refuses to sign an
ABN, the provider has no obligation to provide therapy that he or she believes
will be denied for lack of medical necessity.

In
the coming days, APTA will provide additional resources to members on the application
of the 2013 MMR process. Resources and the latest information on the therapy
cap can be found on APTA's 2013 Medicare Changes webpage.

APTA Seeks Member Comments on Walking for Surgeon General Call to Action

To
address the public health problem of physical inactivity, the Department of
Health and Human Services is accepting comments on walking as an effective way
to be sufficiently active for health. The information collected will help frame
an anticipated Surgeon General's call to action on this issue.

APTA
will submit comments by the April 30 deadline. APTA members are encouraged to send
their recommendations to APTA to be included in the association's submission to
HHS.

The
notice requests
information on ways to increase walking and community walkability on the
following 2 topics:

(1) Barriers
to walking for youth, adults, seniors, people with developmental injury and
chronic disease-related disabilities, racial and ethnic minorities, and
low-income individuals.

(2) Evidence-based
strategies for overcoming those barriers and their reach and impact to increase
physical activity at the population level and among the above-mentioned
subpopulations

Section on Geriatrics Donates $50,000 to the Foundation

A recent $50,000 donation by the
Section on Geriatrics to the Foundation for Physical Therapy will be allocated
toward the Marilyn Moffat Endowment Fund for Geriatric Research ($25,000) and
the Center of Excellence for Health Services/Health Policy Research ($25,000).

Established in 2007, the Marilyn
Moffat Endowment Fund for Geriatric Research supports emerging investigators
examining methods to facilitate the translation of research into current
physical therapy practice with aging adults.

The Center of Excellence is a new
initiative with a goal to provide health services and health policy research
training to prepare physical therapist scientists to examine physical therapy
resource utilization, costs, and quality. The purpose of the research is to
identify the most effective ways to deliver, organize, finance, and assess
outcomes of health care services.

If
you're not receiving the Foundation for Physical Therapy's monthly News &
Events e-newsletter, sign up today and stay current with the latest
information on research supported by the Foundation, funding and awards, and
events. The newsletter also provides links to information about the
Foundation's trustees and staff; scholarships, fellowships, and grants; and how
to make a donation.

Final Rule Establishes Matching Rates for Medicaid Beneficiaries

The Centers for Medicare and Medicaid
Services (CMS) issued a final rule
Friday implementing provisions of the Affordable Care Act (ACA) on increased Federal Medical Assistance Percentage (FMAP), or matching, rates for certain Medicaid
beneficiaries in states. This rule codifies the increased FMAP rates that will
be applicable beginning January 1, 2014.

An increased FMAP rate is available
for medical services provided to people defined as "newly eligible"
who are enrolled in the new eligibility group for adults up to 133% of the poverty
level. In general, individuals are "newly eligible" if they are
enrolled in the new adult group and would not have been eligible for full
benefits, benchmark benefits, or benchmark-equivalent benefits under the
eligibility rules in that state in effect in December 2009. The newly
eligible FMAP is 100% in calendar years 2014-2016, 95% in calendar year 2017,
94% in calendar year 2018, 93% in calendar year 2019, and 90% in calendar years
2020 and beyond.

CMS also establishes an increased
FMAP for expenditures for nonpregnant, childless individuals in the new adult
eligibility group in a defined "expansion state." The expansion
state FMAP is the regular FMAP rate increased by the number of percentage
points equal to a "transition percentage" (that ranges from 50%-100%)
of the gap between the regular Medicaid FMAP and the increased "newly
eligible" FMAP. In 2019 and beyond, the expansion state FMAP will be equal
to the newly eligible FMAP, which means it will be 93% in 2019 and 90% in 2020
and thereafter.

The final rule also describes the
threshold methodology that states will use to claim the new FMAP rates.

CMS is seeking comment on selected
provisions of this final rule through June 3 so that the agency can determine
whether additional clarification would assist states to implement these aspects
of the threshold methodology more effectively.

Older Cancer Survivors Present Unique Challenge to Health Care System

The
growing number of older cancer survivors presents a unique challenge to the
health care system because they are more likely to have multiple chronic
diseases and tend to experience poorer physical functioning than younger
survivors, says an NBC article based on a study published in Cancer
Epidemiology, Biomarkers & Prevention.

More than 13 million people had
survived cancer and were still alive in the United States as of January 1,
2012. Nearly two-thirds of them were considered "cured," having
survived 5 years or more. Forty percent had survived 10 years; 15% had lived 20
years past their diagnosis. The study's authors project that the ranks of
cancer survivors will grow by nearly a third over the next 10 years.

"By 2020, two-thirds of cancer
survivors are going to be age 65 or older," said Julia Rowland, PhD, the
study's lead author and director of the Office of Cancer Survivorship at the
National Cancer Institute, a part of the National Institutes of Health (NIH).

"Provision of high-quality
care for older adult survivors may require adoption of new metrics and
strategies," the authors write. "These include the use of geriatric
assessments of health and quality of life, the development of geriatric cancer
rehabilitation programs, and the development of multidisciplinary teams with
expertise in older adults' complex and unique needs. Optimally, these teams
will include geriatric specialists in social work, psychology (or neuropsychology),
nursing, rehabilitation, and oncology, along with geriatricians."

Rowland and colleagues say a
concerted effort is needed to better describe older cancer survivors, define
and refine standards of quality care for them, and develop delivery systems
that reflect the multifaceted needs of this diverse and vulnerable
population.